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31.10.30.00.htm 31.10.30.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 30 Disability Benefit Claims Procedures Authority: Insurance Article, §2-109(a)1) and 15-1010, Annotated Code of Maryland
31.10.30.01.htm 31.10.30.01. 01 Scope.. This chapter applies to insurers that issue or deliver individual or group health insurance policies in Maryland that include a disability benefit.
31.10.30.02.htm 31.10.30.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Adverse appeal determination" means a decision made by an insurer on an appeal of an adverse benefit determination to uphold:a) A denial, reduction, or termination of a disability benefit;. b) A failure to provide or make payment, in whole or in part, for a disability benefit; or. c) Any denial, reduction, termination, or failure to provide or make paymen
31.10.30.03.htm 31.10.30.03. 03 Establishment of Claim and Appeal Procedures.. A. Each insurer subject to this chapter shall establish procedures for processing disability benefits claims and appeals of adverse benefit determinations in accordance with this chapter.B. The procedures established by an insurer shall:. 1) Be in writing;. 2) Contain administrative processes and safeguards designed to ensure and to verify that benefit claim determinations are made in accordance with the insurance policy provisio
31.10.30.04.htm 31.10.30.04. 04 Timing and Content of Notice of Adverse Benefit Determination.. A. An insurer shall give written or electronic notice that complies with the standards imposed by 29 CFR §2520.104b-1(c)1)i) (iii) and (iv) of an adverse benefit determination to a covered individual within a reasonable period of time, but not later than 45 days after receipt of a claim for disability benefits, unless the 45-day period is extended in accordance with this regulation.B. Subject to §F(2) of th
31.10.30.05.htm 31.10.30.05. 05 Timing and Notice of an Appeal Determination.. A. An insurer shall give written or electronic notice that complies with the standards imposed by 29 CFR §2520.104b-1(c)1)i) (iii) and (iv) of an appeal determination to a covered individual within a reasonable period of time, but not later than 45 days after receipt of an appeal of an adverse benefit determination, unless the 45-day period is extended in accordance with this regulation.B. Subject to §E of this
31.10.30.9999.htm 31.10.30.9999. Administrative History Effective date: August 2, 2004 (31:15 Md. R. 1186).
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